AB0266 PREGNANCY PLANNING AND FOLLOW-UP IN MULTIDISCIPLINARY UNITS IMPROVES THE OUTCOMES IN WOMEN WITH INFLAMMATORY ARTHROPATHIES
Authors: L. Vega, O. Ibarguengoitia, C. García, M. Enjuanes, E. Galíndez-Agirregoikoa, I. Calvo, J. M. Blanco, A. R. Inchaurbe, I. Torre, O. Fernandez, C. E. Perez, E. Cuande, M. R. Exposito-Molinero, I. Gorostiza, J. Oraa, M. L. García Vivar, M. E. Ruiz
Journal: Annals of the Rheumatic Diseases (2022)

Background Women with inflammatory arthropaties (IA) have fertility problems and complications during pregnancy and frequently biological therapy (BT) is required for the disease control. Objectives To evaluate pregnancy in women with IA in a multidisciplinary unit composed of Rheumatologists and Obstetricians: describe disease evolution, complications and treatment. Methods Retrospective and descriptive study of the evolution of pregnancy in patients with IA [Rheumatoid Arthritis (RA), Spondyloarthritis (SpA), Psoriatic arthritis (PsA) and Juvenile Idiopathic Arthritis (JIA)] and follow-up in a multidisciplinary unit for more than 15 years (until December 2021). Demographics, maternal disease, time until conception, previous abortions and presence of antibodies were collected. In addition, during follow-up, treatment, abortions, cesarean sections (C-section), preterm births, disease activity and maternal/fetal complications were collected. Results We registered 49 pregnancies (39 women): 27 RA (55.1%), 9 SpA (18.4%), 9 PsA (18.4%) and 4 JIA (8.1%). Maternal average age at diagnosis was 26.8±6.7 years and average age at childbirth/abortion was 34.5±5.3 years. It took an average time of 9±7.7 months to conceive. 8.2% received fertility treatment with in vitro fertilization techniques. AntiRo antibodies were registered in 6.3% of patients and 28.6% had at least 1 antiphospholipid antibody. At the time of gestational desire/gestation 24 women (13 RA, 5 SpA, 3 PsA, 3 JIA) were receiving BT: 14 certolizumab (CZP), 5 adalimumab (ADA), 4 etanercept (ETN). 1 patient was being treated with baricitinib (BARI). Due to pregnancy, ADA was changed to CZP in 3 women and BT was stopped in 6 cases (3 ETN, 2 ADA, 1 CZP) as well as BARI. In 2 cases, ADA was stopped at week 17 of pregnancy (medical indication). Pregnancy was completed with BT (CZP) in 15 cases. 9 abortions were registered prior to follow-up in the unit (0.23 abortions/mother) and 3 (2 RA, 1 PsA) during follow-up (0.07 abortions/mother): 2 (1 RA, 1 PsA) of them in women with CZP. RA patient had positive antiphospholipid antibodies and was a smoker and the other one had moderate disease activity by the time of the abortion. C-section was performed in 26.1% of cases. Preterm birth (&lt;37 weeks) happened in 8.2% (n: 4) of the pregnancies: 2 in women with CZP. A total of 19 different fetal/maternal complications were registered during follow-up: 8 in the BT group (42.1%) compared to 11 (57.9%) in the group without BT, being Intrauterine Growth Restriction (IUGR) more frequent among women with BT. Infections were not more common in patients with BT. Table 1. Table 1. COMPLICATIONS WITH BT (n, %) n: 17 WITHOUT BT (n, %) n: 32 IUGR 3 (17.6) 1 (3.1) LBW 2 (11.8) 2 (6.2) INFECTION 1 (5.9) 4 (12.5) CHOLESTASIS 0 (0) 2 (6.2) PREECLAMPSIA 0 (0) 1 (3.1) DM 2 (11.8) 1 (3.1) HIGH BLOOD PRESSURE 0 (0) 0 (0) NEPHROPATY 0 (0) 0 (0) NEONATAL LUPUS 0 (0) 0 (0) HEART BLOCK 0 (0) 0 (0) MALFORMATION 0 (0) 0 (0) HELLP SYNDROME 0 (0) 0 (0) TOTAL 8 11 Regarding concomitant treatment, low dose prednisone was used in 32.7% of pregnancies, hydroxychloroquine in 44.9%, sulfasalazine in 8.2% and acetylsalicylic acid in 51%. We didn´t find differences in the use of these treatments between the two groups. Median DAS28 among RA patients with available data was under 2.6 throughout pregnancy as well as previously and posteriorly. No differences in median DAS28 were found between women with BT and without BT. SpA patients had BASDAI lower than 4 in both groups during pregnancy and previously. Conclusion In our series, as described in the literature, women with IA are older and more likely to have preterm births compared to general population. Appropriate disease control was maintained during pregnancy, also previously and afterwards. We registered more IUGR, low birth weight (LBW) and diabetes mellitus (DM) among women with BT but lower rate of infections. Given the low number of patients with BT no statistically significant conclusions about complications can be drawn. Therefore, more studies among pregnant women with BT are necessary. Disclosure of Interests None declared